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Heyerdahl LW, Dielen S, Dodion H, Van Riet C, Nguyen T, Simas C, Boey L, Kattumana T, Vandaele N, Larson HJ, Grietens KP, Giles-Vernick T, Gryseels C. Strategic silences, eroded trust: The impact of divergent COVID-19 vaccine sentiments on healthcare workers' relations with peers and patients. Vaccine 2023; 41:883-891. [PMID: 36319488 PMCID: PMC9606030 DOI: 10.1016/j.vaccine.2022.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Polarized debates about Covid-19 vaccination and vaccine mandates for healthcare workers (HCWs) challenge Belgian HCWs ability to discuss Covid-19 vaccine sentiments with peers and patients.Although studies have identified drivers of HCWs vaccine hesitancy, they do not include effects of workplace interactions and have not addressed consequences beyond vaccine coverage. METHODS Interviews and focus group discussions with 74 HCWs practicing in Belgium addressed Covid-19 vaccine sentiments and experiences of discussing vaccination with peers and patients. RESULTS Most participating HCWs reported difficulties discussing Covid-19 vaccination with peers and patients. Unvaccinated HCWs often feared that expressing their vaccine sentiments might upset patients or peers and that they would be suspended. Consequently, they used social cues to evaluate others' openness to vaccine-skeptical discourses and avoided discussing vaccines. Surprisingly, some vaccine-confident HCWs hid their vaccine sentiments to avoid peer and patient conflicts. Both vaccinated and unvaccinated HCWs observed that unvaccinated patients occasionally received suboptimal care. Suboptimal care was central in unvaccinated HCW unwillingness to express their vaccine sentiments to peers. Both vaccinated and unvaccinated HCWs described loss of trust and ruptured social relations with peers and patients holding divergent vaccine sentiments. DISCUSSION Belgian HCW perceived Covid-19 vaccines as a risky discussion topic and engaged in "strategic silences" around vaccination to maintain functional work relationships and employment in health institutions. Loss of trust between HCW and peers or patients, along with suboptimal patient care based on vaccination status, threaten to weaken Belgium's, and by implication, other health systems, and to catalyze preventable disease outbreaks.
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Affiliation(s)
- Leonardo W Heyerdahl
- Department of Global Health, Anthropology and Ecology of Disease Emergence Unit, Institut Pasteur, Paris, France.
| | - Stef Dielen
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Hélène Dodion
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - ToTran Nguyen
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Clarissa Simas
- Vaccine Confidence Project and London School of Hygiene and Tropical Medicine, United Kingdom
| | - Lise Boey
- Access-To-Medicines Research Centre, KU Leuven, Belgium
| | - Tarun Kattumana
- Access-To-Medicines Research Centre, KU Leuven, Belgium; Husserl Archives, Research Center for Phenomenology and Continental Philosophy, Institute of Philosophy, KU Leuven, Belgium
| | - Nico Vandaele
- Access-To-Medicines Research Centre, KU Leuven, Belgium
| | - Heidi J Larson
- Vaccine Confidence Project and London School of Hygiene and Tropical Medicine, United Kingdom
| | - Koen Peeters Grietens
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Tamara Giles-Vernick
- Department of Global Health, Anthropology and Ecology of Disease Emergence Unit, Institut Pasteur, Paris, France
| | - Charlotte Gryseels
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium
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de Figueiredo A, Simas C, Larson HJ. COVID-19 vaccine acceptance and its socio-demographic and emotional determinants: A multi-country cross-sectional study. Vaccine 2023; 41:354-364. [PMID: 36414475 PMCID: PMC9647027 DOI: 10.1016/j.vaccine.2022.10.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Multiple COVID-19 vaccines have now been licensed for human use, with other candidate vaccines in different stages of development. Effective and safe vaccines against COVID-19 have been essential in achieving global reductions in severe disease caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), but multiple factors, including vaccine supply and vaccine confidence, continue to impact global uptake of COVID-19 vaccines. In this study, we explore determinants of COVID-19 vaccination intent across17 countries worldwide. METHODS In this large-scale multi-country study, we explored intent to accept a COVID-19 vaccine and the socio-demographic and emotional determinants of uptake for 17 countries and over 19,000 individuals surveyed in June and July 2020 via nationally representative samples. We used Bayesian ordinal logistic regressions to probe the relationship between intent to accept a COVID-19 vaccine and individuals' socio-demographic status, their confidence in COVID-19 vaccines, and their recent emotional status. Gibbs sampling was used for Bayesian model inference, with 95% Bayesian highest posterior density intervals used to capture uncertainty. FINDINGS Intent to accept a COVID-19 vaccine was found to be highest in India, where 77⋅8% (95% HPD, 75⋅5 to 80⋅0%) of respondents strongly agreeing that they would take a new COVID-19 vaccine if it were available. The Democratic Republic of Congo (15⋅5%, 12⋅2 to 18⋅6%) and France (26⋅4%, 23⋅7 to 29⋅2%) had the lowest share of respondents who strongly agreed that they would accept a COVID-19. Confidence in the safety, importance, and effectiveness of COVID-19 vaccines are the most widely informative determinants of vaccination intent. Socio-demographic and emotional determinants played a lesser role, with being male and having higher education associated with increased uptake intent in five countries and being fearful of catching COVID-19 also a strong determinant of uptake intent. INTERPRETATION Barriers to COVID-19 vaccine acceptance are found to be country and context dependent. These findings highlight the importance of regular monitoring of COVID-19 vaccine confidence to identify groups less likely to vaccinate.
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Affiliation(s)
- A de Figueiredo
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - C Simas
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - H J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA; Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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Heyerdahl LW, Dielen S, Nguyen T, Van Riet C, Kattumana T, Simas C, Vandaele N, Vandamme AM, Vandermeulen C, Giles-Vernick T, Larson H, Grietens KP, Gryseels C. Doubt at the core: Unspoken vaccine hesitancy among healthcare workers. Lancet Reg Health Eur 2021; 12:100289. [PMID: 34927116 PMCID: PMC8668386 DOI: 10.1016/j.lanepe.2021.100289] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Affiliation(s)
- Leonardo W Heyerdahl
- Department of Global Health, Anthropology and Ecology of Disease Emergence Unit, Institut Pasteur, Paris, France
| | - Stef Dielen
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - ToTran Nguyen
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Tarun Kattumana
- Access-To-Medicines Research Centre, KU Leuven, Belgium.,Husserl Archives, Research Center for Phenomenology and Continental Philosophy, Institute of Philosophy, KU Leuven, Belgium
| | - Clarissa Simas
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Nico Vandaele
- Access-To-Medicines Research Centre, KU Leuven, Belgium
| | - Anne-Mieke Vandamme
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Institute for the Future, Leuven, Belgium.,Center for Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Corinne Vandermeulen
- Youth Health Care, Environment and Health Leuven University Vaccinology Centre KU Leuven, Belgium
| | - Tamara Giles-Vernick
- Department of Global Health, Anthropology and Ecology of Disease Emergence Unit, Institut Pasteur, Paris, France
| | - Heidi Larson
- Vaccine Confidence Project and London School of Hygiene and Tropical Medicine, United Kingdom
| | - Koen Peeters Grietens
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Charlotte Gryseels
- Socio-Ecological Health Research Unit, Institute of Tropical Medicine, Antwerp, Belgium
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Simas C, Larson HJ, Paterson P. ''Those who do not vaccinate don't love themselves, or anyone else'': a qualitative study of views and attitudes of urban pregnant women towards maternal immunisation in Panama. BMJ Open 2021; 11:e044903. [PMID: 34417210 PMCID: PMC8381308 DOI: 10.1136/bmjopen-2020-044903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To identify pregnant women's views and attitudes towards maternal immunisation in Panama based on in-depth interviews and focus groups. SETTING Two main urban centres in Panama (San Miguelito and Panama City). PARTICIPANTS Fifty-six pregnant women from Panama City (n=29) and San Miguelito (n=27). METHODS In-depth interviews and focus groups were conducted, audio-recorded, transcribed verbatim and analysed using a deductive-inductive approach. RESULTS Our findings suggest that this population perceives vaccination as a key component of maternal healthcare, not an elective part of it. The pregnant women interviewed disclosed a heightened perception of vulnerability to infectious diseases. For this reason, safety and effectiveness of maternal vaccines were closely associated for many participants (a vaccine was perceived as safe if it was effective against disease). Refusal of maternal vaccination was strongly associated with parental negligence. Participants reported the participation of husbands and partners in the decision-making around their health. Most participants reported high information-seeking behaviour, particularly online; many interviewees confirmed any information obtained online with their healthcare professionals (HCPs). Vaccine recommendations from HCPs appeared to be one of the main predictors of maternal immunisations among the sample interviewed. While acceptability of maternal vaccines was high in this sample, some pregnant women expressed concerns and doubts (e.g., that maternal vaccines could cause miscarriages) which require attention. Finally, many participants reported difficulties in accessing maternal vaccination, pointing to financial and physical barriers. CONCLUSIONS The acceptability of maternal immunisation was high among the interviewed women. The pregnant women's receptiveness to maternal vaccinations, even when information provided was limited, is suggestive of high levels of trust in HCPs. Even so, HCPs and health officials should remain alert to apprehensions expressed by pregnant women. Many participants reported struggles in accessing maternal vaccination, pointing to issues that merit further examination.
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Affiliation(s)
- Clarissa Simas
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Heidi J Larson
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Department of Health Metrics Sciences, University of Washington, Seattle, Washington, USA
| | - Pauline Paterson
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health Research Health Protection Research Unit (NIHR-HPRU) in Immunisation, London School of Hygiene and Tropical Medicine in partnership with Public Health England, London, UK
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Simas C, Paterson P, Lees S, J Larson H. "From my phone, I could rule the world": Critical engagement with maternal vaccine information, vaccine confidence builders and post-Zika outbreak rumours in Brazil. Vaccine 2021; 39:4700-4704. [PMID: 34229891 DOI: 10.1016/j.vaccine.2021.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Abstract
Maternal immunization is key to protecting maternal and newborn health. We interviewed pregnant women in Brazil to identify barriers to and enablers of maternal immunization in the country. In-depth interviews and focus groups were conducted in Brazil with 60 pregnant women from São Paulo and Rio de Janeiro at different stages of their pregnancies. Participants were encouraged to discuss views on safety, efficacy and importance of maternal vaccines, access to vaccines, interactions with healthcare professionals, and sources of information on vaccine-related matters. There was generally a positive regard for maternal immunization among the interviewed women, many of whom associated vaccination with protection of their unborn child. The interviewees cited several reasons for adherence to immunization guidelines, including recommendations from healthcare professionals, targeted communication campaigns, and active use of a vaccination card or booklet. There were no reported barriers for maternal vaccines. Some women using private healthcare services reported not having been asked about vaccines at check-ups, which could adversely affect vaccination rates. A rumour that vaccines caused microcephaly which emerged during the Zika outbreak was the most commonly cited reason for choosing not to vaccinate among the interviewees. This study identified important vaccine confidence builders. Many of the interviewees critically reflected upon information received, placing themselves as the decision makers over their health choices. A prominent barrier to maternal immunization was a rumour linking vaccines to microcephaly. To the best of our knowledge, this has not been previously reported in the literature and requires further investigation into the extent of this issue and how it can be mitigated.
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Affiliation(s)
- Clarissa Simas
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Pauline Paterson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Health Protection Research Unit (NIHR-HPRU) in Immunisation, London School of Hygiene & Tropical Medicine in partnership with Public Health England, London, UK
| | - Shelley Lees
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Heidi J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Health Metrics Siences, University of Washington, Seattle, USA
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Larson HJ, Sahinovic I, Balakrishnan MR, Simas C. Vaccine safety in the next decade: why we need new modes of trust building. BMJ Glob Health 2021; 6:bmjgh-2020-003908. [PMID: 34011503 PMCID: PMC8137162 DOI: 10.1136/bmjgh-2020-003908] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/04/2022] Open
Abstract
Among the realm of highly varied vaccine perceptions and concerns expressed by publics around the world, vaccine safety is the most frequently cited. While many of the safety questions raised have substantial evidence to address the concerns, vaccines do have small risks, and need vigilant and responsive systems to address them. With more and more new vaccines, combinations of vaccines and new technologies to develop and deliver them, new safety concerns will arise that need attention. Adding to this landscape is the dramatic impact which digital communication has had on how fast rumours and vaccine concerns can spread, making the task of the public health and scientific community even more pressing. One of the more recently characterised vaccine safety issues, now named 'immunisation stress-related-response,' has gained particularly high visibility given these highly globally connected social media networks. To better anticipate and address these rapidly shared vaccine safety concerns, a number of global efforts and local responses are being made. Co-created social media campaigns engaging parents and adolescents have been effective, while the WHO's Vaccine Safety Net (VSN) initiative has grown its global network to increase awareness about vaccines and contribute to building confidence in vaccines. The VSN reviews websites around the world to assess their quality and accuracy to ensure and promote access to trustworthy and science-based information on vaccine safety for internet users. These and the efforts of the multiple network partners are more crucial than ever to sustain public confidence in this evolving vaccine safety landscape.
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Affiliation(s)
- Heidi J Larson
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Clarissa Simas
- Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Simas C, Larson HJ, Paterson P. "Saint Google, now we have information!": a qualitative study on narratives of trust and attitudes towards maternal vaccination in Mexico City and Toluca. BMC Public Health 2021; 21:1170. [PMID: 34144703 PMCID: PMC8212502 DOI: 10.1186/s12889-021-11184-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/28/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Maternal vaccination is key to decreasing maternal and infant mortality globally. Yet perceptions about maternal vaccines and immunization among pregnant women are often understudied, particularly in low- and middle- income countries. This qualitative study explored trust, views, and attitudes towards maternal immunization among pregnant women in Mexico. A total of 54 women from Mexico City and Toluca participated in the in-depth interviews and focus groups. We explored participants' experiences with maternal vaccination, as well as how they navigated the health system, searched for information, and made decisions around maternal immunization. RESULTS Our findings point to issues around access and quality of maternal healthcare, including immunizations services. While healthcare professionals were recognized for their expertise, participants reported not receiving enough information to make informed decisions and used online search engines and digital media to obtain more information about maternal healthcare. Some participants held strong doubts over the benefits of vaccination and were hesitant about the safety and efficacy of maternal vaccines. These concerns were also shared by pregnant women who had been vaccinated. Some participants disclosed low levels of trust in government and vaccination campaigns. CONCLUSION Pregnant women, soon to be parents and making vaccination decisions for their child, constitute an important target group for policymakers seeking optimal maternal as well as childhood immunization coverage. Our findings highlight the importance of targeted communication, trust-building and engagement strategies to strengthen confidence in immunization amongst this group.
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Affiliation(s)
- Clarissa Simas
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Heidi J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Department of Health Metrics Sciences, University of Washington, Seattle, USA
| | - Pauline Paterson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- National Institute for Health Research Health Protection Research Unit (NIHR-HPRU) in Immunisation, London School of Hygiene and Tropical Medicine in partnership with Public Health England, London, UK
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Karafillakis E, Martin S, Simas C, Olsson K, Takacs J, Dada S, Larson HJ. Methods for Social Media Monitoring Related to Vaccination: Systematic Scoping Review. JMIR Public Health Surveill 2021; 7:e17149. [PMID: 33555267 PMCID: PMC7899807 DOI: 10.2196/17149] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 11/05/2020] [Accepted: 12/17/2020] [Indexed: 01/26/2023] Open
Abstract
Background Social media has changed the communication landscape, exposing individuals to an ever-growing amount of information while also allowing them to create and share content. Although vaccine skepticism is not new, social media has amplified public concerns and facilitated their spread globally. Multiple studies have been conducted to monitor vaccination discussions on social media. However, there is currently insufficient evidence on the best methods to perform social media monitoring. Objective The aim of this study was to identify the methods most commonly used for monitoring vaccination-related topics on different social media platforms, along with their effectiveness and limitations. Methods A systematic scoping review was conducted by applying a comprehensive search strategy to multiple databases in December 2018. The articles’ titles, abstracts, and full texts were screened by two reviewers using inclusion and exclusion criteria. After data extraction, a descriptive analysis was performed to summarize the methods used to monitor and analyze social media, including data extraction tools; ethical considerations; search strategies; periods monitored; geolocalization of content; and sentiments, content, and reach analyses. Results This review identified 86 articles on social media monitoring of vaccination, most of which were published after 2015. Although 35 out of the 86 studies used manual browser search tools to collect data from social media, this was time-consuming and only allowed for the analysis of small samples compared to social media application program interfaces or automated monitoring tools. Although simple search strategies were considered less precise, only 10 out of the 86 studies used comprehensive lists of keywords (eg, with hashtags or words related to specific events or concerns). Partly due to privacy settings, geolocalization of data was extremely difficult to obtain, limiting the possibility of performing country-specific analyses. Finally, 20 out of the 86 studies performed trend or content analyses, whereas most of the studies (70%, 60/86) analyzed sentiments toward vaccination. Automated sentiment analyses, performed using leverage, supervised machine learning, or automated software, were fast and provided strong and accurate results. Most studies focused on negative (n=33) and positive (n=31) sentiments toward vaccination, and may have failed to capture the nuances and complexity of emotions around vaccination. Finally, 49 out of the 86 studies determined the reach of social media posts by looking at numbers of followers and engagement (eg, retweets, shares, likes). Conclusions Social media monitoring still constitutes a new means to research and understand public sentiments around vaccination. A wide range of methods are currently used by researchers. Future research should focus on evaluating these methods to offer more evidence and support the development of social media monitoring as a valuable research design.
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Affiliation(s)
- Emilie Karafillakis
- London School of Hygiene & Tropical Medicine, Vaccine Confidence Project, London, United Kingdom
| | - Sam Martin
- London School of Hygiene & Tropical Medicine, Vaccine Confidence Project, London, United Kingdom
| | - Clarissa Simas
- London School of Hygiene & Tropical Medicine, Vaccine Confidence Project, London, United Kingdom
| | - Kate Olsson
- European Centre for Disease Prevention and Control, Stockhom, Sweden
| | - Judit Takacs
- European Centre for Disease Prevention and Control, Stockhom, Sweden.,Centre for Social Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Sara Dada
- London School of Hygiene & Tropical Medicine, Vaccine Confidence Project, London, United Kingdom
| | - Heidi Jane Larson
- London School of Hygiene & Tropical Medicine, Vaccine Confidence Project, London, United Kingdom.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
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Simas C, Penn-Kekana L, Kuper H, Lyra TM, Moreira MEL, de Albuquerque MDSV, de Araújo TVB, de Melo APL, Figueira Mendes CH, Nunes Moreira MC, Ferreira do Nascimento MA, Pimentel C, Pinto M, Valongueiro S, Larson H. Hope and trust in times of Zika: the views of caregivers and healthcare workers at the forefront of the epidemic in Brazil. Health Policy Plan 2020; 35:953-961. [PMID: 32681164 PMCID: PMC7553755 DOI: 10.1093/heapol/czaa042] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 12/16/2022] Open
Abstract
This article investigates how hope and trust played out for two groups at the forefront of the Zika epidemic: caregivers of children with congenital Zika syndrome and healthcare workers. We conducted 76 in-depth interviews with members of both groups to examine hope and trust in clinical settings, as well as trust in public institutions, in the health system and in the government of Brazil. During and after the Zika epidemic, hope and trust were important to manage uncertainty and risk, given the lack of scientific evidence about the neurological consequences of Zika virus infection. The capacity of healthcare workers and caregivers to trust and to co-create hope seems to have allowed relationships to develop that cushioned social impacts, reinforced adherence to therapeutics and enabled information flow. Hope facilitated parents to trust healthcare workers and interventions. Hope and trust appeared to be central in the establishment of support networks for caregivers. At the same time, mistrust in the government and state institutions may have allowed rumours and alternative explanations about Zika to spread. It may also have strengthened activism in mother's associations, which seemed to have both positive and negative implications for healthcare service delivery. The findings also point to distrust in international health actors and global health agenda, which can impact community engagement in future outbreak responses in Brazil and other countries in Latin America.
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Affiliation(s)
- Clarissa Simas
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Loveday Penn-Kekana
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Tereza Maciel Lyra
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães/Fiocruz, Avenida Professor Moraes Rêgo, S/N Cidade Universitária. CEP 50740-465, Recife, PE, Brasil
- Department of Social Medicine, Faculty of Medicine, Federal University of Pernambuco, Avenida da Engenharia, S/N, Bloco D, 1º Andar, Cidade Universitária. CEP: 50.740-600 Recife, PE, Brazil
| | - Maria Elisabeth Lopes Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ 20021-140, Brazil
| | - Maria do Socorro Veloso de Albuquerque
- Postgraduate Programme in public Health, Center of Medical Sciences, Federal University of Pernambuco. Avenida Professor Moraes Rêgo, S/N Hospital das Clínicas, Bloco E, 4o.andar. Cidade Unitersitária, CEP 50.670-901, Recife -PE, Brazil
| | - Thália Velho Barreto de Araújo
- Postgraduate Programme in Public Health, Center of Medical Sciences, Federal University of Pernambuco, Avenida Professor Moraes Rêgo, S/N Hospital das Clínicas, Bloco E - 4º Andar, Cidade Universitária, CEP: 50.670-901, Recife, PE, Brazil
| | - Ana Paula Lopes de Melo
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães/Fiocruz, Avenida Professor Moraes Rêgo, S/N Cidade Universitária. CEP 50740-465, Recife, PE, Brasil
- Núcleo de Saúde Coletiva da Universidade Federal de Pernambuco R. Alto do Reservatório - Alto José Leal, Vitória de Santo Antã - PE-Brasil, 55608-250l
| | - Corina Helena Figueira Mendes
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ 20021-140, Brazil
| | - Martha Cristina Nunes Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ 20021-140, Brazil
| | - Marcos Antonio Ferreira do Nascimento
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ 20021-140, Brazil
| | - Camila Pimentel
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães/Fiocruz, Avenida Professor Moraes Rêgo, S/N Cidade Universitária. CEP 50740-465, Recife, PE, Brasil
| | - Marcia Pinto
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ 20021-140, Brazil
| | - Sandra Valongueiro
- Postgraduate Programme in Public Health, Center of Medical Sciences, Federal University of Pernambuco, Avenida Professor Moraes Rêgo, S/N Hospital das Clínicas, Bloco E - 4º Andar, Cidade Universitária, CEP: 50.670-901, Recife, PE, Brazil
| | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK
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de Figueiredo A, Simas C, Karafillakis E, Paterson P, Larson HJ. Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study. Lancet 2020; 396:898-908. [PMID: 32919524 PMCID: PMC7607345 DOI: 10.1016/s0140-6736(20)31558-0] [Citation(s) in RCA: 529] [Impact Index Per Article: 132.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is growing evidence of vaccine delays or refusals due to a lack of trust in the importance, safety, or effectiveness of vaccines, alongside persisting access issues. Although immunisation coverage is reported administratively across the world, no similarly robust monitoring system exists for vaccine confidence. In this study, vaccine confidence was mapped across 149 countries between 2015 and 2019. METHODS In this large-scale retrospective data-driven analysis, we examined global trends in vaccine confidence using data from 290 surveys done between September, 2015, and December, 2019, across 149 countries, and including 284 381 individuals. We used a Bayesian multinomial logit Gaussian process model to produce estimates of public perceptions towards the safety, importance, and effectiveness of vaccines. Associations between vaccine uptake and a large range of putative drivers of uptake, including vaccine confidence, socioeconomic status, and sources of trust, were determined using univariate Bayesian logistic regressions. Gibbs sampling was used for Bayesian model inference, with 95% Bayesian highest posterior density intervals used to capture uncertainty. FINDINGS Between November, 2015, and December, 2019, we estimate that confidence in the importance, safety, and effectiveness of vaccines fell in Afghanistan, Indonesia, Pakistan, the Philippines, and South Korea. We found significant increases in respondents strongly disagreeing that vaccines are safe between 2015 and 2019 in six countries: Afghanistan, Azerbaijan, Indonesia, Nigeria, Pakistan, and Serbia. We find signs that confidence has improved between 2018 and 2019 in some EU member states, including Finland, France, Ireland, and Italy, with recent losses detected in Poland. Confidence in the importance of vaccines (rather than in their safety or effectiveness) had the strongest univariate association with vaccine uptake compared with other determinants considered. When a link was found between individuals' religious beliefs and uptake, findings indicated that minority religious groups tended to have lower probabilities of uptake. INTERPRETATION To our knowledge, this is the largest study of global vaccine confidence to date, allowing for cross-country comparisons and changes over time. Our findings highlight the importance of regular monitoring to detect emerging trends to prompt interventions to build and sustain vaccine confidence. FUNDING European Commission, Wellcome, and Engineering and Physical Sciences Research Council.
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Affiliation(s)
- Alexandre de Figueiredo
- The Vaccine Confidence Project, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Mathematics, Imperial College London, London, UK
| | - Clarissa Simas
- The Vaccine Confidence Project, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Emilie Karafillakis
- The Vaccine Confidence Project, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Pauline Paterson
- The Vaccine Confidence Project, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Heidi J Larson
- The Vaccine Confidence Project, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA; Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
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11
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Vorsters A, Bosch FX, Bonanni P, Franco EL, Baay M, Simas C, Waheed DEN, Castro C, Murillo R, Trujillo L, Wiesner C, Muñoz N. Prevention and control of HPV infection and HPV-related cancers in Colombia- a meeting report. BMC Proc 2020; 14:8. [PMID: 32577128 PMCID: PMC7307134 DOI: 10.1186/s12919-020-00192-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The Human Papillomavirus (HPV) Prevention and Control Board is an independent multidisciplinary board of international experts that disseminates relevant information on HPV to a broad array of stakeholders and provides guidance on strategic, technical and policy issues in the implementation of HPV control programs. In response to drastic drop of vaccine coverage following the adverse event crisis in Carmen del Bolivar, Colombia, the HPV Prevention and Control Board in collaboration with the Colombian National Cancer Institute and Colombian League Against Cancer convened a meeting in Bogota, Columbia (November 2018). The goal of the meeting was to bring together national and international group of experts to report the disease burden, epidemiology and surveillance of HPV and HPV-related cancers, to discuss the successes and especially the challenges of HPV vaccination and screening in Colombia, as well as the lessons learnt from neighbouring countries. The meeting provided a platform to confer various stakeholder's perspectives, including the role of the Colombian healthcare system and to catalyse various parts of the public health community in Colombia into effective action. The conclusion of the meeting included following suggestions to strengthen HPV prevention and control: 1) Re-introducing school-based vaccine programs, 2) Integrating primary and secondary prevention programs, 3) Developing an innovative crisis communication plan targeting healthcare workers, teachers and general population, 4) Building trust through efficient and timely communication, 5) Building strong relationship with media to ensure a stable vaccination campaign support, and 6) Promoting empathy among healthcare professionals towards patients to build trust and communicate effectively.
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Affiliation(s)
- Alex Vorsters
- Centre for Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium
| | - Francesc Xavier Bosch
- Cancer Epidemiology Research Program, IDIBELL, Catalan Institute of Oncology, L'Hospitalet De Llobregat, Barcelona, Spain.,Open University of Catalonia, Barcelona, Spain
| | - Paolo Bonanni
- University of Florence, Health Sciences, Florence, Italy
| | | | - Marc Baay
- P95, Epidemiology and Pharmacovigilance Consulting and Services, Leuven, Belgium
| | - Clarissa Simas
- Infectious Disease and Epidemiology (IDE), London School of Hygiene and Tropical Medicine, London, UK
| | - Dur-E-Nayab Waheed
- Centre for Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium
| | - Carlos Castro
- Colombian League against Cancer Bogota, Bogota, Colombia
| | - Raul Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogota, Colombia
| | - Lina Trujillo
- Instituto Nacional de Cancerología, Bogota, Colombia
| | | | - Nubia Muñoz
- Instituto Nacional de Cancerología, Bogota, Colombia
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12
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Larson H, Simas C, Horton R. The emotional determinants of health: The Lancet-London School of Hygiene & Tropical Medicine Commission. Lancet 2020; 395:768-769. [PMID: 32145776 DOI: 10.1016/s0140-6736(20)30050-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Heidi Larson
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Clarissa Simas
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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13
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Kuper H, Lyra TM, Moreira MEL, de Albuquerque MDSV, de Araújo TVB, Fernandes S, Jofre-Bonet M, Larson H, Lopes de Melo AP, Mendes CHF, Moreira MCN, do Nascimento MAF, Penn-Kekana L, Pimentel C, Pinto M, Simas C, Valongueiro S. Social and economic impacts of congenital Zika syndrome in Brazil: Study protocol and rationale for a mixed-methods study. Wellcome Open Res 2019; 3:127. [PMID: 31667356 PMCID: PMC6807146 DOI: 10.12688/wellcomeopenres.14838.2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2019] [Indexed: 12/22/2022] Open
Abstract
Global concern broke out in late 2015 as thousands of children in Brazil were born with microcephaly, which was quickly linked to congenital infection with Zika virus (ZIKV). ZIKV is now known to cause a wider spectrum of severe adverse outcomes-congenital Zika syndrome (CZS)-and also milder impairments. This study aimed to explore the social and economic impacts of CZS in Brazil. Data was collected through mixed methods across two settings: Recife City and Jaboatão dos Guararapes in Pernambuco State (the epicentre of the epidemic), and the city of Rio de Janeiro (where reports of ZIKV infection and CZS were less frequent). Data was collected May 2017-January 2018. Ethical standards were adhered to throughout the research. In-depth qualitative interviews were conducted with: mothers and other carers of children with CZS (approximately 30 per setting), pregnant women (10-12 per setting), men and women of child-bearing age (16-20 per setting), and health professionals (10-12 per setting). Thematic analysis was undertaken independently by researchers from at least two research settings, and these were shared for feedback. A case-control study was undertaken to quantitatively explore social and economic differences between caregivers of a child with CZS (cases) and caregivers with an unaffected child (controls). We aimed to recruit 100 cases and 100 controls per setting, from existing studies. The primary caregiver, usually the mother, was interviewed using a structured questionnaire to collect information on: depression, anxiety, stress, social support, family quality of life, health care and social service use, and costs incurred by families. Multivariable logistic regression analyses were used to compare outcomes for cases and controls. Costs incurred as a result of CZS were estimated from the perspective of the health system, families and society. Modelling was undertaken to estimate the total economic burden of CZS from those three perspectives.
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Affiliation(s)
- Hannah Kuper
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Tereza Maciel Lyra
- Aggeu Magalhães Institute, FIOCRUZ/PE, Recife, Brazil.,Faculty of Medicine, University of Pernambuco, Recife, Brazil
| | | | | | | | - Silke Fernandes
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana Paula Lopes de Melo
- Aggeu Magalhães Institute, FIOCRUZ/PE, Recife, Brazil.,Public Health Department, Federal University of Pernambuco, Recife, Brazil
| | | | | | | | - Loveday Penn-Kekana
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Marcia Pinto
- Fernando Figueira Maternal and Children's Institute, Rio de Janeiro, Brazil
| | - Clarissa Simas
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Valongueiro
- Postgraduate Programme in Public Health, Federal University of Pernambuco, Recife, Brazil
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14
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Kuper H, Lyra TM, Moreira MEL, de Albuquerque MDSV, de Araújo TVB, Fernandes S, Jofre-Bonet M, Larson H, Lopes de Melo AP, Mendes CHF, Moreira MCN, do Nascimento MAF, Penn-Kekana L, Pimentel C, Pinto M, Simas C, Valongueiro S. Social and economic impacts of congenital Zika syndrome in Brazil: Study protocol and rationale for a mixed-methods study. Wellcome Open Res 2019; 3:127. [PMID: 31667356 DOI: 10.12688/wellcomeopenres.14838.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2018] [Indexed: 11/20/2022] Open
Abstract
Global concern broke out in late 2015 as thousands of children in Brazil were born with microcephaly, which was quickly linked to congenital infection with Zika virus (ZIKV). ZIKV is now known to cause a wider spectrum of severe adverse outcomes-congenital Zika syndrome (CZS)-and also milder impairments. This study aimed to explore the social and economic impacts of CZS in Brazil. Data was collected through mixed methods across two settings: Recife City and Jaboatão dos Guararapes in Pernambuco State (the epicentre of the epidemic), and the city of Rio de Janeiro (where reports of ZIKV infection and CZS were less frequent). Data was collected May 2017-January 2018. Ethical standards were adhered to throughout the research. In-depth qualitative interviews were conducted with: mothers and other carers of children with CZS (approximately 30 per setting), pregnant women (10-12 per setting), men and women of child-bearing age (16-20 per setting), and health professionals (10-12 per setting). Thematic analysis was undertaken independently by researchers from at least two research settings, and these were shared for feedback. A case-control study was undertaken to quantitatively explore social and economic differences between caregivers of a child with CZS (cases) and caregivers with an unaffected child (controls). We aimed to recruit 100 cases and 100 controls per setting, from existing studies. The primary caregiver, usually the mother, was interviewed using a structured questionnaire to collect information on: depression, anxiety, stress, social support, family quality of life, health care and social service use, and costs incurred by families. Multivariable logistic regression analyses were used to compare outcomes for cases and controls. Costs incurred as a result of CZS were estimated from the perspective of the health system, families and society. Modelling was undertaken to estimate the total economic burden of CZS from those three perspectives.
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Affiliation(s)
- Hannah Kuper
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Tereza Maciel Lyra
- Aggeu Magalhães Institute, FIOCRUZ/PE, Recife, Brazil.,Faculty of Medicine, University of Pernambuco, Recife, Brazil
| | | | | | | | - Silke Fernandes
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana Paula Lopes de Melo
- Aggeu Magalhães Institute, FIOCRUZ/PE, Recife, Brazil.,Public Health Department, Federal University of Pernambuco, Recife, Brazil
| | | | | | | | - Loveday Penn-Kekana
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Marcia Pinto
- Fernando Figueira Maternal and Children's Institute, Rio de Janeiro, Brazil
| | - Clarissa Simas
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Valongueiro
- Postgraduate Programme in Public Health, Federal University of Pernambuco, Recife, Brazil
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15
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Simas C, Munoz N, Arregoces L, Larson HJ. Reply letter re: “Mass psychogenic illness following HPV immunization in Carmen de Bolivar, Colombia”. Hum Vaccin Immunother 2019; 15:1201-1202. [PMID: 30946630 PMCID: PMC6605877 DOI: 10.1080/21645515.2019.1586031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- C. Simas
- London School of Hygiene and Tropical Medicine, London, UK
| | - N. Munoz
- Emeritus Professor at the Cancer Institute of Colombia, International Epidemiological Association, Colombia
| | - L. Arregoces
- London School of Hygiene and Tropical Medicine, London, UK
| | - H. J. Larson
- London School of Hygiene and Tropical Medicine, London, UK
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16
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Karafillakis E, Simas C, Jarrett C, Verger P, Peretti-Watel P, Dib F, De Angelis S, Takacs J, Ali KA, Pastore Celentano L, Larson H. HPV vaccination in a context of public mistrust and uncertainty: a systematic literature review of determinants of HPV vaccine hesitancy in Europe. Hum Vaccin Immunother 2019; 15:1615-1627. [PMID: 30633623 PMCID: PMC6783136 DOI: 10.1080/21645515.2018.1564436] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/03/2018] [Accepted: 12/18/2018] [Indexed: 11/15/2022] Open
Abstract
Europe is increasingly described as the region in the world with the least confidence in vaccination, and particularly in the safety of vaccines. The aim of this systematic literature review was to gather and summarise all peer-reviewed and grey literature published about determinants of Human Papillomavirus (HPV) vaccine hesitancy in Europe. Ten thematic categories were identified across the 103 articles which were included in the review. Participants from European studies most commonly reported issues with the quantity and quality of information available about HPV vaccination; followed by concerns about potential side effects of the vaccine; and mistrust of health authorities, healthcare workers, and new vaccines. Comparative analyses indicated that confidence determinants differed by country and population groups. This evidence supports the need to develop context-specific interventions to improve confidence in HPV vaccination and design community engagement strategies aiming to build public trust.
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Affiliation(s)
- Emilie Karafillakis
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Clarissa Simas
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Caitlin Jarrett
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Universität Basel, Basel, Switzerland
| | - Pierre Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- Aix Marseille Université, UMR_S 912, IRD, Marseille, France
- INSERM, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), GH Cochin Broca Hôtel Dieu, Paris, France
| | - Patrick Peretti-Watel
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- Aix Marseille Université, UMR_S 912, IRD, Marseille, France
- INSERM, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), GH Cochin Broca Hôtel Dieu, Paris, France
| | - Fadia Dib
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Department of Social Epidemiology, Paris, France
- INSERM CIC 1417, F-CRIN, I-REIVAC, Paris, France
- Assistance Publique Hopitaux de Paris (AP-HP), Hôpital Cochin, CIC Cochin, Pasteur, Paris, France
| | - Stefania De Angelis
- Vaccine Preventable Disease Programme, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Judit Takacs
- Centre for Social Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Karam Adel Ali
- Vaccine Preventable Disease Programme, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Lucia Pastore Celentano
- Vaccine Preventable Disease Programme, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Heidi Larson
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
- Department of Global Health, Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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17
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Simas C, Munoz N, Arregoces L, Larson HJ. HPV vaccine confidence and cases of mass psychogenic illness following immunization in Carmen de Bolivar, Colombia. Hum Vaccin Immunother 2018; 15:163-166. [PMID: 30118381 PMCID: PMC6363158 DOI: 10.1080/21645515.2018.1511667] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
We report the case of multiple adverse reactions following HPV vaccination in Colombian adolescents in Carmen de Bolivar. In August 2012, the country introduced a school-based HPV immunization programme which successfully reached over 90% of the target population in the first year. In 2014, between May 29th and June 2nd,15 adolescent girls in one school presented adverse reactions after vaccination and were admitted to the local hospital. Soon, videos of girls fainting, twitching, and arriving unconscious at emergency rooms started to appear in national news media as well as on social media platforms such as YouTube. The viral spread of these videos and disturbing images were followed by the viral spread of symptoms, with over 600 cases reported across Colombia. Thorough epidemiological investigation by Colombian health authorities found no organic association between the teenagers' symptoms and the HPV vaccine, concluding this was a case of mass psychogenic reaction to vaccination. Scientific evidence did not appease the anxious public whose confidence in HPV immunization dropped dramatically. By 2016, HPV vaccine uptake among eligible girls declined to 14% for the first dose and 5% for the complete course, down from 98% and 88%, respectively, in 2012. We document this case and discuss the role of news and social media, particularly YouTube, as a driver of contagious psychogenic reactions. We also discuss the role of health authorities and government, and the importance of acting rapidly and appropriately to contain the spread of such symptoms and maintain public confidence in vaccines.
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Affiliation(s)
- Clarissa Simas
- a London School of Hygiene and Tropical Medicine , London , UK
| | - Nubia Munoz
- b Emeritus Professor at the Cancer Institute of Colombia , International Epidemiological Association , Colombia
| | | | - Heidi J Larson
- a London School of Hygiene and Tropical Medicine , London , UK
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18
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Mato R, Sanches IS, Simas C, Nunes S, Carriço JA, Sousa NG, Frazão N, Saldanha J, Brito-Avô A, Almeida JS, de Lencastre H. Natural history of drug-resistant clones of Streptococcus pneumoniae colonizing healthy children in Portugal. Microb Drug Resist 2006; 11:309-22. [PMID: 16359190 DOI: 10.1089/mdr.2005.11.309] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A total of 3,539 Streptococcus pneumoniae (Pn) were recovered from 4,969 nasopharyngeal samples of children attending 13 day-care centers (DCCs) located in Lisbon, Portugal, during a surveillance study from January, 2001, through March, 2003, integrated in the European intervention project (EURIS, European Resistance Intervention Study). All Pn isolates were tested for anti-biotyping and drug-resistant pneumococci (DRPn) were further tested by serotyping and pulsed-field gel electrophoresis (PFGE). Overall carriage of Pn was very high (71.2%) and 39.9% of the isolates were resistant to antimicrobials (22.5% with decreased susceptibility to penicillin and 17.4% susceptible to penicillin and resistant to other antimicrobials). Serotypes 6B, 14, 23 F, 19F, and 19 A were prevalent among the 1,287 DRPn and 5.8% of the isolates were non-typeable. Eighty PFGE patterns were identified among 1,285 DRPn, and 93.1% of the DRPn belonged to 26 major clonal types that comprised: Pneumococcal Molecular Epidemiology Network (PMEN) clones (76.3%), Portuguese (PT)-DCC clones, previously detected in 1996-1999 (14.3%), and EURIS PT-DCC new clones, identified for the first time in the EURIS study, during 2001-2003 (9.4%). Comparing with previous Portuguese surveillance studies carried out since 1996, we observed that carriage increased from 47% to 71%, but no major changes were detected on the prevalence of pneumococcal serotypes. Moreover, although PMEN clones were predominant in all DCCs, in the present study the majority of them were gradually decreasing in time whereas several PT-DCC and new clones seemed to be increasing.
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Affiliation(s)
- R Mato
- Instituto de Tecnologia Química e Biológica da Universidade Nova de Lisboa (ITQB/UNL), 2780-156 Oeiras, Portugal
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19
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Carriço JA, Pinto FR, Simas C, Nunes S, Sousa NG, Frazão N, de Lencastre H, Almeida JS. Assessment of band-based similarity coefficients for automatic type and subtype classification of microbial isolates analyzed by pulsed-field gel electrophoresis. J Clin Microbiol 2005; 43:5483-90. [PMID: 16272474 PMCID: PMC1287802 DOI: 10.1128/jcm.43.11.5483-5490.2005] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pulsed-field gel electrophoresis (PFGE) has been the typing method of choice for strain identification in epidemiological studies of several bacterial species of medical importance. The usual procedure for the comparison of strains and assignment of strain type and subtype relies on visual assessment of band difference number, followed by an incremental assignment to the group hosting the most similar type previously seen. Band-based similarity coefficients, such as the Dice or the Jaccard coefficient, are then used for dendrogram construction, which provides a quantitative assessment of strain similarity. PFGE type assignment is based on the definition of a threshold linkage value, below which strains are assigned to the same group. This is typically performed empirically by inspecting the hierarchical cluster analysis dendrogram containing the strains of interest. This approach has the problem that the threshold value selected is dependent on the linkage method used for dendrogram construction. Furthermore, the use of a linkage method skews the original similarity values between strains. In this paper we assess the goodness of classification of several band-based similarity coefficients by comparing it with the band difference number for PFGE type and subtype classification using receiver operating characteristic curves. The procedure described was applied to a collection of PFGE results for 1,798 isolates of Streptococcus pneumoniae, which documented 96 types and 396 subtypes. The band-based similarity coefficients were found to perform equally well for type classification, but with different proportions of false-positive and false-negative classifications in their minimal false discovery rate when they were used for subtype classification.
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Affiliation(s)
- J A Carriço
- Biomathematics Group, Universidade Nova de Lisboa, Rua da Quinta Grande 6, 2780-156 Oeiras, Portugal.
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20
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Aires de Sousa M, Conceição T, Simas C, de Lencastre H. Comparison of genetic backgrounds of methicillin-resistant and -susceptible Staphylococcus aureus isolates from Portuguese hospitals and the community. J Clin Microbiol 2005; 43:5150-7. [PMID: 16207977 PMCID: PMC1248511 DOI: 10.1128/jcm.43.10.5150-5157.2005] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2005] [Accepted: 07/11/2005] [Indexed: 11/20/2022] Open
Abstract
In order to understand the origins of the dominant methicillin-resistant Staphylococcus aureus (MRSA) clones in Portuguese hospitals, we compared the genetic backgrounds of nosocomial MRSA with methicillin-susceptible S. aureus (MSSA) isolates from the same hospitals (n=155) and from the community (n=157) where they were located. Pulsed-field gel electrophoresis, spa typing, multilocus sequence typing, and agr type analysis revealed that the genetic backgrounds correspondent to the dominant MRSA clones in Portuguese hospitals during the last 15 years (Iberian ST 247, Brazilian ST 239, and EMRSA-15 ST 22) were scarcely or not found among the present MSSA collection. The four major MSSA clones encountered (A-ST 30, B-ST 34, C-ST 5, and H-ST 45) correspond, or are very similar, to the background of other international MRSA pandemic clones, i.e., EMRSA-16, New York/Japan, Pediatric, and Berlin clones. However, with the exception of the Pediatric clone, none of these MRSA clones has been detected in Portugal. Our findings suggest the three major MRSA clones identified in Portuguese hospitals have not originated from the introduction of SCCmec into dominant MSSA backgrounds present in the Portuguese nosocomial or community environment but were probably imported from abroad. In contrast, the MRSA Pediatric clone might have originated in our country by the acquisition of SCCmec type IV into MSSA clone C. Furthermore, we provide evidence that the introduction of SCCmec into sensitive clones is most likely a relatively infrequent event that seems to depend not exclusively on the presence of a successful MSSA lineage.
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Affiliation(s)
- M Aires de Sousa
- Laboratório de Genética Molecular, Instituto de Tecnologia Química e Biológica da Universidade Nova De Lisboa, Oeiras, Portugal
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